Available evidence suggests that hand hygiene promotion (HHP) with a multimodal intervention will be the most effective approach to improve HCW hand hygiene compliance[6]. While formal evaluation of such an intervention using a strong study design in lower and middle income countries is lacking, such interventions are relatively inexpensive and thought likely to be cost-effective (and potentially cost-saving as a result of reduced infections rates). Again, however, formal economic evaluations outside high income countries are lacking.